Being accused of healthcare fraud is one of the most stressful things a medical professional can face. One day you’re running a practice; the next, you’re getting calls from federal investigators or receiving a subpoena you don’t fully understand. If this is happening to you, a Star Valley healthcare fraud lawyer at Suzuki Law Offices can help you figure out what to do next.
These cases almost always involve federal agencies, including the FBI, the Department of Justice, or HHS-OIG, and they move quickly. As Star Valley federal crimes lawyers serving clients throughout the area, Suzuki Law Offices knows how these investigations are built and how to push back. We’re available 24/7, and your first consultation is free.
What Counts as Healthcare Fraud?
Healthcare fraud doesn’t always look obvious. In fact, many people facing these charges didn’t set out to do anything wrong. Under federal law, specifically 18 U.S.C. § 1347, healthcare fraud means knowingly submitting false or misleading information to obtain payment from a health benefit program. That includes Medicare, Medicaid, TRICARE, and private insurers.
Common examples include:
- Billing for services that were never provided
- Upcoding: billing for a more expensive procedure than what was actually done
- Unbundling: splitting one procedure into multiple claims to get paid more
- Accepting or paying kickbacks for patient referrals
- Billing for medically unnecessary services
- Falsifying patient records to justify a claim
The key word in all of this is knowingly. The government has to prove you intended to deceive, not just that a billing error occurred. That distinction is often where a Star Valley criminal defense lawyer will start building your claim.
Why These Cases Go Federal
If your practice bills Medicare or Medicaid, expect the federal government to be involved. Federal prosecutors have bigger budgets and the ability to push for harsher sentences than you’d typically see in state court. That’s a different level of pressure entirely, and it shows how important it is to have a Star Valley healthcare fraud attorney in your corner.
Here’s what that can mean financially: under the False Claims Act, the government can fine you between $13,946 and $27,894 for each false claim submitted, not just the total amount billed. If investigators identify dozens or hundreds of questionable claims, those numbers stack up fast, and that’s before any criminal penalties are even on the table.
It’s also worth knowing that Arizona has its own healthcare fraud law that covers the state’s Medicaid program, known as AHCCCS. That means you could potentially face both state and federal charges for the same conduct; two separate cases, two separate sets of consequences, running at the same time.
Deadlines You Need to Know
Time is of the essence, both for the government and for you. Here are some of the deadlines that apply to a Star Valley healthcare fraud case.
- Federal statute of limitations: The government generally has 5 years from the date of the alleged offense to bring criminal charges under 18 U.S.C. § 3282. For cases involving Medicare or Medicaid fraud specifically, that window can extend to 10 years under 18 U.S.C. § 3293.
- False Claims Act civil cases: The government has 6 years from the violation, or 3 years from when it knew (or should have known) about it; whichever is later, up to a maximum of 10 years.
- Arizona AHCCCS fraud: Under A.R.S. § 36-2918, the state can pursue civil recovery for up to 6 years.
What this means practically: an investigation can gradually build for years before you ever see a charge. By the time you’re contacted, the government may already have a substantial file on you. It’s important to get in touch with a Star Valley healthcare fraud lawyer as soon as possible.
How Healthcare Fraud Investigations in Star Valley Usually Start
Most people don’t get a knock on the door first. Healthcare fraud investigations typically begin with one of these:
- A subpoena for billing records, patient charts, or financial documents
- An audit notice from Medicare, Medicaid, or a private insurer
- A visit or call from an FBI agent or HHS-OIG investigator
- A whistleblower complaint filed by a current or former employee under the False Claims Act
If any of these have happened to you, take it seriously, even if no charges have been filed yet. What you say and do right now can shape the entire case. Make sure to consult a healthcare fraud lawyer in Star Valley before you take any further action.
How We Defend Healthcare Fraud Cases in Star Valley
Every case is different, but there are several defense strategies that come up regularly in healthcare fraud matters:
Lack of Intent
The government must prove you knowingly committed fraud. If billing errors were the result of software defaults, poor training, coding confusion, or delegated tasks you weren’t aware of, that’s a meaningful defense.
Challenging the Evidence
Federal agents must follow the law when gathering evidence. If a search warrant was overbroad, if records were seized improperly, or if your rights were violated during questioning, those issues can be raised to suppress evidence or challenge the case entirely.
Disputing the Loss Amount
Prosecutors often inflate the alleged loss figure, which directly affects sentencing. We scrutinize those numbers carefully because even a small reduction can significantly change your exposure.
Negotiating a Resolution
Not every case goes to trial. When the facts support it, we work to negotiate reduced charges, civil settlements, or outcomes that protect your license and keep you out of prison.
Speak With a Star Valley Healthcare Fraud Lawyer
If you’ve been contacted by investigators, received a subpoena, or you’re worried about a billing audit that’s gone further than expected, don’t wait. The sooner you have legal representation, the more options you have.
Suzuki Law Offices represents healthcare professionals and practice owners in Star Valley facing federal and state fraud allegations. We’re available 24/7, and we’ll treat your case with the urgency and care it deserves. Contact us today for a free consultation.
Call or text (602) 682-5270 or complete a Free Case Evaluation form